Economist John Cawley discusses economics of obesity

Before developing specific anti-obesity strategies, lawmakers and advocates should review the evidence on program effectiveness and costs to avoid policies that won't work or will waste money, says Cornell economist John Cawley, in "The Economics of Childhood Obesity," published in the journal Health Affairs March 2.

Cawley, associate professor of policy analysis and management, argues that government spending should focus on programs that offer "the biggest bang for the buck." In his paper, Cawley examines recent studies of several youth-focused initiatives to reduce obesity, finding that CATCH (Coordinated Approach to Child Health), a multistate program that teaches elementary schoolchildren how to eat well and exercise regularly, is the most cost-effective. It costs $900 per "quality-adjusted life-year," a standard measure of the benefits of public health interventions. By comparison, a study of "walking school buses," a popular approach that encourages children and adults to walk to school together, found the program to be ineffective.

"There is widespread recognition that childhood obesity is a problem in need of attention and resources," said Cawley, who has served on the Institute of Medicine's committee to prevent childhood obesity. "But it's a bit of a Wild West, anything-goes environment when it comes to creating anti-obesity programs and policies. With limited resources, it would be counterproductive to rush into programs that are not cost-effective and won't provide the greatest return on investment."

The "walking school bus" sounds like a neat idea, but it doesn't increase kids' physical activity or prevent obesity. "Every county, employer, school, day care and community agency is trying to do something about obesity right now, which is great, but we also need to evaluate these programs so we can learn what works," he said.

Public support for anti-obesity policies hinges greatly upon how cost is framed, says Cawley, who obtained these results from the 2009 Empire State Poll conducted by the Cornell Survey Research Institute. Without mention of costs, 92 percent of 800 New Yorkers polled agreed that the government should improve nutrition in school cafeterias. However, when people were asked whether taxes should be raised to improve nutrition in school cafeterias, support falls to 41 percent.

Cawley's paper also describes the economic contributors to, and the consequences of, sharply rising childhood obesity rates in recent decades and describes the economic case for government interventions. In 2008, obesity added more than $27 billion in costs to Medicare and Medicaid, which are funded by taxpayer dollars, and it contributed $49 billion to private health insurer costs. Therefore it makes sense for government to reduce and prevent obesity, in order to limit these costs imposed on the general population, he says.